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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
AFRICA
73
Prevalence, awareness, treatment and control of
hypertension, diabetes and hypercholesterolaemia
among adults in Dande municipality, Angola
João M Pedro, Miguel Brito, Henrique Barros
Abstract
Objectives:
To estimate the prevalence, awareness, treatment
and control of hypertension, diabetes and hypercholesterol-
aemia in an Angolan population aged 15 to 64 years and to
determine relationships with sociodemographic, behavioural
and anthropometric characteristics.
Methods:
A total of 2 354 individuals were assessed for behav-
ioural, sociodemographic and physical characteristics in a
cross-sectional, community-based survey. Post-stratification
survey weights were applied to obtain prevalence levels.
Adjusted odds ratios for each variable related to the condi-
tions were calculated using logistic regression models.
Results:
Overall, the prevalence of hypertension was 18.0%,
diabetes 9.2% and hypercholesterolaemia 4.0%. Among
hypertensive individuals, the awareness rate was 48.5%;
15.8% were on treatment and 9.1% had their blood pressure
controlled. Only 10.8% were aware they had diabetes, 4.5%
were on treatment and 2.7% were controlled. The awareness
level for hypercholesterolaemia was 4.2%, with 1.4% individu-
als on treatment and 1.4% controlled.
Conclusions:
The prevalence levels of hypertension and diabe-
tes, which were higher than previous findings for the region,
together with the observed low rates of awareness, treatment
and control of all conditions studied, constitute an additional
challenge to the regional health structures, which must rapidly
adapt to the epidemiological shift occurring in this population.
Keywords:
epidemiology, hypertension, diabetes, hypercholester-
olaemia, sub-Saharan Africa
Submitted 25/11/16, accepted 7/11/17
Published online 14/12/17
Cardiovasc J Afr
2017;
29
: 73–81
www.cvja.co.zaDOI: 10.5830/CVJA-2017-047
Cardiovasculardisease(CVD),amajorcauseof non-communicable
diseases (NCDs), was responsible for 17.5 million deaths
worldwide in 2012, most occurring in low- and middle-income
countries (LMIC). In Africa, the frequency of NCDs is rising
rapidly, reflecting the combined effect of population growth and
ageing, as well as nutritional and epidemiological transitions.
1
A large proportion of CVD is the result of exposure to
modifiable risk factors (tobacco and alcohol consumption,
unhealthy diet and physical inactivity), which influence metabolic
pathways and ultimately result in obesity, hypertension, diabetes or
hypercholesterolaemia.
1,2
Together, these known adverse conditions
explain approximately half of CVD cases, as demonstrated in the
MONICA project and the INTERHEART study.
3,4
Among the African population participating in the
INTERHEART study, five risk factors (smoking, diabetes,
hypertension, abdominal obesity and an elevated apolipoprotein
B to apolipoprotein A-1 ratio) accounted for 89.2% of the
population-attributable risk for the first myocardial infarction.
5
The same study suggested that uncontrolled major risk factors
have a larger impact on the burden of CVD in Africa than
elsewhere in the world.
5
If the current trends persist, the risk of dying from NCDs
will increase in the African region. However, this rising risk
could be reversed by reaching the proposed targets for six
behavioural and physiological risk factors (tobacco and alcohol
use, salt intake, obesity and increased blood pressure and glucose
levels) out of the nine global targets proposed by the World
Health Organisation (WHO) in the Global Action Plan for the
Prevention and Control of NCD 2013–2020.
6,7
To follow the achievement of those goals, there is a need for
sound and updated epidemiological data from all regions of the
world. The majority of published studies for the African region
are conducted at hospital services, which does not allow one
to detect risk factors, awareness rates and prevalence of such
conditions in the general population.
8-10
To provide core data on
established risk factors for the major NCDs within the context
of low-resource settings, WHO designed the STEPwise approach
to Surveillance (STEPS).
11
STEPS uses a modular structure with
standardised questions and protocols, allowing adjustment of its
application and appropriate comparisons across surveys.
11
In Angola, infectious disease and maternal and child health-
related problems remain the major causes of morbidity and
mortality.
12
However, an increased burden of NCDs has been
observed, particularly CVD, which was responsible for 9% of
adult deaths in 2013.
13
Beyond general vital statistics, specific
epidemiological information on CVD risk factors in Angola is
based on only four local studies published after 2000: a survey
of 667 adult students of Health Sciences in Lubango (prevalence
of hypertension of 23.5%),
14
a study conducted among 615
active employees of the University Agostinho Neto, Luanda
CISA, Centro de Investigação em Saúde de Angola, Caxito,
Angola
João M Pedro, BPharm, MEd,
joao.almeidapedro@cisacaxito.orgMiguel Brito, PhD
EPIUnit, Instituto de Saúde Pública, Universidade do Porto,
Porto, Portugal
João M Pedro, BPharm, MEd
Henrique Barros, MD, PhD
Escola Superior de Tecnologia da Saúde de Lisboa,
Instituto Politécnico de Lisboa, Lisboa, Portugal
Miguel Brito, PhD
Faculdade de Medicina, Universidade do Porto, Porto, Portugal
Henrique Barros, MD, PhD